More than 3 000 cases of mpox have been recorded in Madagascar after the virus spread from a single port city to some of the country’s busiest coastal hubs, with experts fearing the true scale of the outbreak may already be larger than official figures suggest, reports The Telegraph.
A total of 3 022 cases and 20 deaths had been recorded as of last week, with cases in Toamasina and Taolagnaro accounting for more than half of all diagnoses.
The outbreak has been linked to Clade 1b mpox, a strain that emerged in the Democratic Republic of the Congo in 2024, prompting the World Health Organisation (WHO) to declare a global public health emergency at the time.
“The main factor driving the continued spread is human mobility, seeding new outbreaks in areas where the virus has not circulated before,” Professor Carlos Maluquer de Motes of the University of Surrey told The Telegraph.
“Under-reporting is likely, with the real number of cases exceeding what is being reported.”
The viral disease was first identified in monkeys in 1958, with the first human case recorded in 1970 in the DRC. It is endemic in parts of Central and West Africa, where it typically spreads from infected animals to humans and then between people through close physical contact.
Scientists believe the virus arrived in the Madagascan port city of Mahajanga via sea trading routes early this year, before spreading through the country’s commercial transport networks to Toamasina and Taolagnaro.
About 65% of mpox tests carried out in Madagascar have come back positive, WHO data show, which experts believe is a sign that many cases may be going undetected.
“The high rate of cases testing positive indicates surveillance is inadequate,” said Dr Jonas Albarnaz, a Fellow at the Pirbright Institute. “Limited resources, competing public health priorities, misdiagnosis, and the cultural stigma surrounding mpox can contribute to under-reporting.”
Madagascar’s Ministry of Health is working with the WHO to expand testing capacity and contact tracing in the worst-affected districts. It remains unclear whether the current strain circulating differs in severity from the one that spread in the DRC.
In Madagascar, the world’s fifth poorest country, vaccine availability and healthcare infrastructure are likely to limit how far immunisation programmes can reach.
The Telegraph article – Explosive mpox outbreak causes 3,000 cases in Madagascar
See more from MedicalBrief archives:
Madagascar reports first mpox death
WHO ends mpox public health emergency, Africa CDC extends it
WHO extends mpox emergency after African surge